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PHTY301 - Musc of Axial Skeleton, If Suspecting: compromised nerve root: …
PHTY301 - Musc of Axial Skeleton
Cervical
Neck Pain
Neck pain with radiating pain
cervical radiculopathy
Early: Manual traction, lat glide, PPIVM lat.flex or rotation
Later: PPIVM lat.flex or rotation, PAIVM
Education: pain relief from GP, avoiding compressive movements/positions
Neck pain with Mobility Deficit
Acute Wry Neck
Manual traction, gentle lat.flex or rotation into ease, heat+gentle massage
Education: sleeping positions, movement lying to sitting
Chronic neck pain w Mobility deficit
Cx mobilisations, manual traction
Exercises: DNF (w PBU), Cx extensor retraining
Education: pain
Neck pain with movement coordination disorders
Whiplash Associated Disorders
Canadian Cx Spine Rules
Education: return to ADL, expected recovery 2-3months
Exercises: DNF (w PBU), Cx extensor retraining, Cx proprioception
Sustained Postural Pain Disorder
Cervical Myelopathy
Degenerative Arthritis
Upper Cervical Spine Dysfunction
Neck pain with headaches
Cervicogenic headache
Acute: SNAGs and self-SNAGs to C1-2
Subacute: SNAGs + Cx mobilisation
Chronic:
Exercise: motor control / endurance of DNF
Migraine
Tension-type headache
Red Flags + non PT neck disorders
VBI (vertebrobasilar insufficlency/vertebral artery insufficiency)
VBI dissection
Upper Cervical Ligament Instability
3Ns, 5Ds
Dizzyness
Diplopia (double vision)
dysarthria (difficulty speaking)
dysphagia (difficulty swallowing)
drop-attacks (sudden falling)
Nystagmus
Nausea
Numbness
Concussion
Cervicogenic Dizzyness
https://www.youtube.com/shorts/IP8WfQzelko
Lumbar (biopsychosocial)
biological structures
vertebral and sacral bones
5Lx, Sacrum, Coccyx
vertebral body, endplate, processes
Muscles
local
global
buttock, hamstring, thigh, calf, foot
Nerve tissue
CNS
sciatic, femoral nerves, nerve roots, cauda equina, lumbar plexus
Joint
IV disc
Z/facet joints
SI joint
Hip
spinal canal
LBP biology
SLBP - specific patho-anatomical Dx (5-10%)
Neuropathic Pain
radiculopathy (nerve root symptoms)
foraminal stenosis from osteophytes
disc herniation
spondylolisthesis
central stenosis
radicular pain vs radiculopathy
symptomatic IV joint pathology
terms: herniation - disc bulge - uncovered disc
Degrees of herniation or is it a continuum: localised herniation - protrusion - extrusion - sequestration
Fractures/bony lesions
OP
metastatic
Fractures
Spondylolysis/pars defect
Spondylolisthesis
stenosis (foraminal or central)
From indirect trauma: stress #, aging, compressive
From direct trauma
Arthritic changes
Ankylosing spondylitis
Spondylosis (basically spinal OA)
Z-joint pathology
Muscle pain and other soft tissue
:red_flag: Serious spinal pathology (2%) --> refer immediately
malignancy/metastatic, infection, inflammatory disease
cauda equina syndrome
progressing neurological signs
severe unrelenting pain not responsive to medication
myelopathy
NSLBP (90-95%)
Mobility disorder
postural loading disorder
motor control disorder
Key wordings:
Lumbar sprain (ligament),
lumbar strain (muscle),
mechanical LBP (provoked by movement
Mckenzie Approach to Rx
Psychological factors
Psychosocial Factors
Pain as a classification: nociceptive, neuropathic, nociplastic
Pain Education
Possible symptoms: stiffness, pain, ache, burning, stabbing, P/N, throbbing, weakness/giving away, just not right
acute/acute on persistent vs. sub-acute vs. persistent LBP
pain education -
https://www.youtube.com/watch?v=ZQsvKjKLlBg
Pelvic Girdle Pain and SIJ
excessive force closure
Impaired force closure
Patterns of pain
pain populations
form closure vs force closure
Specific PGP, NSPGP (including pregnancy related)
pregnancy related NSPGP explained -
https://www.youtube.com/watch?v=AmDxtQtJV_0
Thoracic
ANAT: articulations of Thx spine
Zygapophyseal
Costovertebral
Costotransverse
costochondral + sternocostal
less that 35% of Thx Spine pain has mechanical origin so check for other sources/red flags
Mechanical origin
Cervico-thoracic Postural Pain
Thoracic Spine acute sprain
Acute 'locked' joint
mid thoracic instability
Thoracic hypomobility disorders
Rib stress #
Side strains
Costochondritis + Tietze's syndrome
Thoracic OP
Non-mechanical origin
Fracture
Vertebral #
Rib #
OP
Inflammatory
ankylosing spondylitis
Visceral presentation referred pain
Viral (shingles etc.)
organ referred pain
Tumour/malignancy/metastatic
Developmental/postural Spinal Conditions in young people
Scoliosis
Scheuermann's Disease
Slightly mechanical Syndromes
Thoracic Outlet Syndrome
T4 Syndrome
Disc herniation etc.
:red_flag: Red flags
severe unremitting pain
PMHx cancer
prolonged use of corticosteroids
systemic unwell
weight loss
saddle anaesthesia, bowel dysfunction
SOB/chest pain exertion
systemic issues
Post-op PT
McKenzie Approach
Derangement: directional preference --> centralising
Dysfunction: change in structure that needs to be loosened
Postural: normal physiology - bad posture/prolonged position
CLINICAL REASONING :silhouette::
Subjective:
stage of condition (acute vs. chronic)
MOI/gradual
Aggravating/relieving/irritability
screen for red flags + yellow flags (psychosocial)
Risk Factors and General health +Meds
Neuro involvement / special questions
previous Ix and medical/AH involvement
Goals
Objective Ax:
AROM Pain Pattern
regular Compressive (eg. R LF, ext, R rotation all provoke pain
Z-joint
Radiculopathy (by foraminal stenosis or disc pathology or spondylolisthesis)
Spinal Stenosis
OA
Spondylolysis
regular Stretch
Ligament strains
Instability/postural conditions
nerve root irritation/radiculopathy from neural tension
Muscle/myofascial pain
Irregular
Often indicates systemic problem, or centrally mediated pain
McKenzie Approach w repetitive motion
Centralising (making condition better - consider for Rx)
Peripheralising (worsening condition)
Category of pain
Nociceptive
Neuropathic
Nociplastic
Manual
PPIVMs
Segmental mobility
PAIVMs
Quality and quantity of movement in joint + pain provocation
Motor Control
Cx
DNF
DN ext.
Lx
TrA (TVA)
Neurological deficits (if indicated) + Neurodynamics
If Suspecting:
compromised nerve root:
segmental rotation (pain side up)
segmental lateral flexion (pain side up)
transverse glides towards pain side
Discal Pathology:
rotation (pain side up)
Z-joint pathology:
unilateral PAIVM
segmental rotation or LF
Always // (reassess)